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Metanálisis y Revisión Sistemática de las Pacientes Embarazadas con Sospecha de Embolismo de Pulmón en el Servicio de Urgencias
Author(s) -
Kline Jeffrey A.,
Richardson Danielle M.,
Than Martin P.,
Penaloza Andrea,
Roy PierreMarie
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12471
Subject(s) - medicine , pulmonary embolism , emergency department , meta analysis , confidence interval , funnel plot , pregnancy , cochrane library , venous thrombosis , relative risk , publication bias , pediatrics , thrombosis , obstetrics , psychiatry , biology , genetics
Objectives Pregnancy causes a small increase in risk of venous thromboembolism ( VTE ), but a large increase in concern upon presentation to an emergency department ( ED ) with symptoms of pulmonary embolism ( PE ), which may cause physicians to employ a low test threshold. This was a systematic review with the hypothesis that symptomatic pregnant patients in the ED have a low relative risk ( RR ) for VTE outcome. Methods Studies in all languages were identified by structured search of PubMed, EMBASE , the Cochrane library, and bibliographies in February 2014. Papers with ED patients evaluated for possible PE that included pregnancy status, and had adequate reference standards, were included. An outcome of VTE (either deep venous thrombosis [ DVT ] or PE ) was considered disease‐positive ( VTE +). Papers were assessed for selection and publication bias, and heterogeneity (I 2 ). The random effects model was used if I 2 > 24%. Results Seventeen full‐length studies of 25,339 patients were analyzed. Pooled data showed I² = 0% with a symmetrical funnel plot. Two small studies with less than 1% of all patients had evidence of selection bias. The frequency of VTE + rate among the 506 pregnant patients was 4.1% (95% confidence interval [ CI ] = 2.6% to 6.0%), compared with 12.4% (95% CI = 9.0% to 16.3%) among nonpregnant patients. The pooled RR of pregnancy for VTE + diagnosis was 0.60 (95% CI = 0.41 to 0.87). Patients in the third trimester had a RR of 0.85 (95% CI = 0.40 to 1.77), and patients of childbearing age (≤45 years) had a RR of 0.56 (95% CI = 0.34 to 0.93). Conclusions In the ED setting, physicians test for PE in pregnant patients at a low threshold, resulting in a low rate of VTE diagnosis and a RR of VTE that is lower than that for nonpregnant women of childbearing age who are tested for PE in the ED setting.